HomeMy WebLinkAboutPietrodangelo OFFICE OF THE TOWN CLERK
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Town of Southold `� CCS
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadS
P. O. Box 1179 '� ) �E M
Southold, New York 11971
Telephone ( ;,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR43 Residential
Fee $ 25.00 Non-Residential X
Septic Cesspool X
NAME OF OWNER: Mary and John.Pietrodangelo
OWNER MAILING ADDRESS: Box 516
Southold, New York 11971
OWNER PROPERTY ADDRESS: 56475 Main Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-4040
TAX MAP NO. : Section 63 Block 3 Lot 14
CROSS STREET: Locust Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: 1982
•
Judith T. Terry
Southold Town Clerk
DATE: July 29, 1987
(TOWN SEAL) -
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OFFICE OF THE TOWN CLERK �FFD(,(r ,`p
Town of Southold ��o _ • e& --, Application No.A/
Judith T. Terry, Town Clerk .�
Town Hall, 53095 Main Road
P. O. Box 1179 c ;L."-,'' 5 1 Residential
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r1 �a' n° `'
� Non-Residential /
Southold, New York 11971 $
Telephone -0.1.73:
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(516) 765-1801
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE -74St 2
OWNER NAME: hIc ( ¢ L Co 'l /`et-P/DelF/7 ell
OWNER MAILING ADDRESS:
6)-f--60 (( h C-1 // -7 ,
OWNER PROPERTY ADDRESS:
fr-Q k1 C/ Jf '5) 7i
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 6t Block j Lot / V
CROSS STREET: e< G C1 j I.11A.)a
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L/ New Existing f/
Residential Non-Residential
?LOCADATE OF PREVIOUS PUMP-OUT: /9-21 _.-
LOCATION
TION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
( e,boek,
Si. ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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